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Fool me 40 times

I spoke with MESA Executive Director Liz Moran today, following up on her members’ brainstorming session.

She said there was a lot of participation and a lot of input, but the overall theme was: there’s some mutual culpability for HME fraud.

Yes, fraudsters shouldn’t target Medicare and home medical equipment, putting the funding in jeopardy that people all over the country need to be safe and healthy at home. But shouldn’t CMS have some safeguards in place?

Liz told me about an incident years ago where CMS paid out more than 40 times for the same wheelchair with the same serial number. Seriously? I’d think a second-year computer programming student could come up with a code to prevent that particular error.

“We vehemently oppose fraud,” Liz told me.

That’s a sentiment I hear echoed by all of the providers and stakeholders we talk to each month.

Since competitive bidding is supposed to be in place to prevent fraud, the MESA brainstorming session was full of alternatives that would prevent fraud but also prevent small businesses from closing their doors.

Among them: nationwide licensure and increased surety bonds.

These ideas had a lot of pros and cons, of course, but I think the goal is a great one.

Think about the money to be saved if fraudsters aren’t paid in the first place? Or the money that could be saved by not having to pay auditors to find typos on claims that will be paid anyway.

I saw a report today that Medicare paid $5.1 billion to nursing homes that don’t meet minimum standards. The OIG issues reports like this all the time, and, if even half of them hold water, maybe CMS should rethink the way it spends its money—whether to fraudsters selling HME out of mailboxes or nursing homes that don’t provide sufficient care to patients.